You’re 40 Years Old; Should You Have a Mammogram?

PJ Hamel Health Guide
  • Before 2009, it was a rule virtually carved in stone: when a woman turns 40, she should start having an annual mammogram. Then the United States Preventive Services Task Force (USPSTF) came out with new recommendations: mammograms starting at age 50, and then only every other year. Massive public and institutional backlash against this recommendation (including lack of support from the American Cancer Society) threw the whole subject into turmoil. Since then, women have wondered – “SHOULD I have a mammogram at age 40, or wait till I’m 50?” New research, released this week, helps clarify the issue.

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    The USPSTF breast cancer screening guidelines proposed 3 years ago never really caught on. When everyone from Department of Health and Human Services Secretary Kathleen Sebelius (HHS funded the USPSTF study) to the American Cancer Society backed off their support, women as a whole breathed a sigh of relief; no need to rethink the long-held belief that “early detection saves lives.”

    Still, the USPSTF guidelines, while unpopular, do make sense – broadly speaking. Each year, about 39 million American women have screening mammograms. Many millions are called back for additional views; and many of those end up undergoing a biopsy which identifies a benign breast condition of some sort: no cancer.

    In addition, research shows that many of the women whose early cancer is identified via mammogram either end up being aggressively over-treated (having a mastectomy for a pre-cancer, for instance); or would have had the same outcome even if their cancer was discovered later – e.g., by feeling a lump. (My October, 2011 post, Do You REALLY Need a Regular Mammogram?, explores this issue.)

    So, after all the mammograms, callbacks, ultrasounds, MRIs, biopsies, and countless hours and days of emotional distress suffered by many millions of women, what’s the bottom line – how many lives are actually saved by a woman learning of her cancer via a mammogram?

    Research shows somewhere between 4,000 and 18,000 American women a year have their lives saved thanks to early detection of their cancer via mammogram.

    Eighteen thousand lives aren’t insignificant – especially to those living them and their loved ones. But neither is the expense, on so many levels, of saving those lives. And that’s where many of us might take pause. Is the cost to society worth the benefit? In these days of soaring health-care expense, this isn’t just a rhetorical question.

    Two studies published Monday in the Annals of Internal Medicine shed additional critical light on this subject. To sum them up, research shows that for women with 1.9 times the general risk of being diagnosed with breast cancer as the general population, beginning mammograms at age 40 carries the same benefit as it does for women age 50 to 74 receiving every-other-year mammograms: the USPSTF recommendation.

    In other words, if you’re 40 years old and your breast cancer risk is about double that of most women, you should start your mammograms at age 40; the benefit outweighs both cost and risk.


  • How do you determine if your breast cancer risk meets this threshold?

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    Two simple ways: if you have a daughter, sibling, or mother with breast cancer (especially if any were diagnosed before age 40), your risk of being diagnosed is at least double that of the general populace.

    Ditto if you have extremely dense breasts – a condition only your doctor can diagnose, and then only via mammogram results. To ascertain your breast density, ask your doctor for your BI-RADS score, which would have been part of the mammogram results; if you’re category 4, you have extremely dense breasts.

    A combination of other risk factors may elevate you to doubled risk, including a BI-RADS score of 3; not having had children (or having your first child after age 30); and taking oral contraceptives. You and your doctor should discuss all of your potential risk factors, and whether they might double your risk of breast cancer.

    Looking at this new evidence, is risk-based screening for breast cancer, based on risk-tailored guidelines, in our future?

    Dr. Otis Brawley, chief medical officer for the American Cancer Society, seems to think so. In an editorial accompanying the papers published this week in the Annals, he wrote, “If screening efforts could focus on women at greatest risk for breast cancer, the number of women harmed would decrease and the number benefiting would increase… There may be recommendations that some women at very high risk get annual testing, some at intermediate risk get biennial testing, and some at normal risk start screening at a later age,” wrote Brawley. (Phend, 2012)

    For now, your best bet is to follow the USPSTF’s revised guidelines, which stuck to the original screening parameters, but added this advice: each woman should make her own decision about when to start screening mammograms, based on discussions with her physician.

    Sources

    Phend, C. (2012, April 30). Breast screening in 40s proposed based on risk. Retrieved from http://www.medpagetoday.com/OBGYN/BreastCancer/32423

    Doheny, K. (2012, April 30). Here are the women who need mammograms in their 40s: Study. Retrieved from http://health.msn.com/health-topics/breast-cancer/here-are-the-women-who-need-mammograms-in-their-40s-study

    Stein, R. (2012, April 30). Studies reignite mammography debate for middle-aged women. Retrieved from http://www.npr.org/blogs/health/2012/04/30/151655064/studies-reignite-mammography-debate-for-middle-aged-women




     

Published On: May 02, 2012